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In their correspondence, Trivellin and Stratakis1 compare the genetic lesions and clinical features of patients with CD40LG duplication-associated autoimmune disease2 to those of patients with X-linked acrogigantism (X-LAG).3 As they correctly point out, both groups possess X-chromosome duplications that include CD40LG, yet patients with X-LAG do not appear to experience autoimmune disease. Although we have not had the opportunity to study X-LAG immune cells, we suspect their lymphocytes do not overexpress CD40L as our male CD40LG duplicated patient's lymphocytes do.

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